Cecilia Arana Håkanson1, Fanny Fredriksson2, Helene Engstrand Lilja3. 1. Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. 2. Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Section of Pediatric Surgery, Uppsala University Children's Hospital, Uppsala, Sweden. 3. Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Section of Pediatric Surgery, Uppsala University Children's Hospital, Uppsala, Sweden. Electronic address: helene.lilja@kbh.uu.se.
Abstract
BACKGROUND: The aims of this study were to compare the incidence of small bowel obstruction (SBO) requiring laparotomy after laparoscopic appendectomy (LA) and open appendectomy (OA) in children and to identify risk factors for SBO. METHODS: Medical records of patients who underwent appendectomy from 2000 to 2014 at our department of Pediatric Surgery were reviewed. Risk factors were analyzed using Cox proportional hazard regression. RESULTS: Totally 619 out of 840 patients were included. OA was performed in 474 (76.6%), LA in 130 patients (21%), and 15 (2.4%) were converted from LA to OA. Age, sex and proportion of perforated appendicitis were comparable in the LA and OA groups. Median follow-up time was 11.4 years (2.6-18.4). The incidence of SBO after LA was 1.5%, after OA 1.9% and in the converted group 6.7% (p = 0.3650). There were no significant differences in the incidence of postoperative intraabdominal abscess, wound infection or length of stay between LA and OA. Perforation and postoperative intra-abdominal abscess were identified as risk factors with 9.03 (p < 0.001) and 6.98 (p = 0.004) times higher risk of SBO, respectively. CONCLUSIONS: The risk for SBO after appendectomy in children was significantly related to perforated appendicitis and postoperative intra-abdominal abscess and not to the surgical approach. LEVEL OF EVIDENCE: Level III.
BACKGROUND: The aims of this study were to compare the incidence of small bowel obstruction (SBO) requiring laparotomy after laparoscopic appendectomy (LA) and open appendectomy (OA) in children and to identify risk factors for SBO. METHODS: Medical records of patients who underwent appendectomy from 2000 to 2014 at our department of Pediatric Surgery were reviewed. Risk factors were analyzed using Cox proportional hazard regression. RESULTS: Totally 619 out of 840 patients were included. OA was performed in 474 (76.6%), LA in 130 patients (21%), and 15 (2.4%) were converted from LA to OA. Age, sex and proportion of perforated appendicitis were comparable in the LA and OA groups. Median follow-up time was 11.4 years (2.6-18.4). The incidence of SBO after LA was 1.5%, after OA 1.9% and in the converted group 6.7% (p = 0.3650). There were no significant differences in the incidence of postoperative intraabdominal abscess, wound infection or length of stay between LA and OA. Perforation and postoperative intra-abdominal abscess were identified as risk factors with 9.03 (p < 0.001) and 6.98 (p = 0.004) times higher risk of SBO, respectively. CONCLUSIONS: The risk for SBO after appendectomy in children was significantly related to perforated appendicitis and postoperative intra-abdominal abscess and not to the surgical approach. LEVEL OF EVIDENCE: Level III.
Authors: Thomas Zheng Jie Teng; Xuan Rong Thong; Kai Yuan Lau; Sunder Balasubramaniam; Vishal G Shelat Journal: World J Gastrointest Surg Date: 2021-11-27